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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374604072
Report Date: 07/16/2021
Date Signed: 07/16/2021 07:00:50 PM

Document Has Been Signed on 07/16/2021 07:00 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108
FACILITY NAME:SILVER OAKS COUNTRY ESTATES IIFACILITY NUMBER:
374604072
ADMINISTRATOR:ECKERT, LORENAFACILITY TYPE:
740
ADDRESS:146 SUN VILLA COURTTELEPHONE:
(760) 415-8216
CITY:VISTASTATE: CAZIP CODE:
92084
CAPACITY: 6CENSUS: 6DATE:
07/16/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
01:20 PM
MET WITH:Henry Showah, LicenseeTIME COMPLETED:
02:30 PM
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Licensing Program Analyst (LPA), Carmen Lopez, made an unannounced visit to the facility to conduct an annual required licensing inspection. LPA identified herself and was granted entry by Jessica Rentera (Yanez). LPA met with Sarah K. McKenzie, Director of Services, and discussed the purpose of today’s visit. Licensee, Dr. Henry Showah, arrived later to join the inspection.

A tour of the facility was conducted inside and out. LPA, accompanied by Sarah McKenzie conducted a general overall inspection, with specific focus on infection control protocols.

During today's inspection LPA observations include the following: Symptom screening procedures/ for staff, residents and visitors; posted signs regarding visitor policy, promoting hand washing, cough and sneeze etiquette and other infection control procedures; Hand hygiene practices; testing plan and procedures; plans for containing infections, PPE supplies procedures and training; and disinfection procedures.

Based on today’s inspection, no deficiencies were observed. An exit interview was conducted with Sarah K. McKenzie, Director of Services, and Dr. Henry Showah, Licensee. A copy of this report, along with the Licensee Rights (01/2016) was emailed to Sarah K. McKenzie, Director of Services, and Dr. Henry Showah, Licensee, at the conclusion of the visit. LPA requested Sarah K. McKenzie or Dr. Henry Showa to send LPA an electronic message reply confirming receipt of these documents.

LPA requested Sarah K. McKenzie, Director of Services, to submit a current Designation of Administrative Responsibility LIC 308, Personnel Report LIC 500 and Emergency Disaster Plan LIC 610-E to the licensing office within 10 business days. Forms available at www.ccld.ca.gov.
SUPERVISORS NAME: Rebecca Hedgecock
LICENSING EVALUATOR NAME: Carmen Lopez
LICENSING EVALUATOR SIGNATURE: DATE: 07/16/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/16/2021
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
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